Skip to main content

Advertisement

SpringerLink
Log in

Impact of a reduction in follow-up frequency on life expectancy in uterine cervical cancer patients

  • Original Article
  • Published:
International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

The appropriate interval of post-treatment follow-up appointments for uterine cervical cancer is unclear. The aim of this study was to investigate the impact of reducing the frequency of post-treatment follow-up examinations on life expectancy and medical expenses in cervical cancer patients.

Methods

Cervical cancer patients who were treated with radiotherapy between 2008 and 2017, underwent a less frequent follow-up program, and subsequently developed recurrent disease were included in consecutive group (CG). Non-randomized groups of cervical cancer patients who underwent a frequent follow-up program after radiotherapy between 1997 and 2007, and subsequently developed recurrent disease were also identified through a chart review and served as a comparison group (primary group [PG]). Clinical data regarding the primary disease, follow-up, recurrence, and survival were collected. Univariate and multivariate analyses of predictors of survival were performed.

Results

A total of 263 recurrent cervical cancer patients (PG: 154, CG: 109) were included in the current study. A reduction in follow-up frequency of up to 40% did not increase the frequency of symptomatic recurrence (PG: vs. CG: 31.2% vs. 35.8%, p = 0.43) or reduce the median overall survival periods of recurrent cervical cancer patients (PG vs. CG: 32 months vs. 36 months, p = 0.15). However, the reduction in the follow-up frequency significantly reduced follow-up costs.

Conclusion

Reducing the frequency of follow-up by up to 40% did not result in shorter overall survival compared with a conventional follow-up program. The results of this study provide a rationale for future studies investigating the optimal follow-up schedule for patients with cervical cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Siegel RL, Miller KD, Jemal A (2018) Cancer statistics, 2018. CA Cancer J Clin 68:7–30

    Article  PubMed  Google Scholar 

  2. Tewari KS, Sill MW, Long HJ 3rd et al (2014) Improved survival with bevacizumab in advanced cervical cancer. N Engl J Med 370:734–743

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Leath CA 3rd, Straughn JM Jr (2013) Chemotherapy for advanced and recurrent cervical carcinoma: results from cooperative group trials. Gynecol Oncol 129:251–257

    Article  CAS  PubMed  Google Scholar 

  4. Rustin GJ, van der Burg ME, Griffin CL et al (2010) Early versus delayed treatment of relapsed ovarian cancer (MRC OV05/EORTC 55955): a randomised trial. Lancet 376:1155–1163

    Article  PubMed  Google Scholar 

  5. NCCN Guidelines Version 2.2019. https://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed 21 Dec 2018

  6. ESGO-ESTRO-ESP Cervical Cancer Guidelines. https://guidelines.esgo.org/media/2018/04/ESGO_Cervical-Cancer_A6.pdf. Accessed 21 Dec 2018

  7. Mabuchi S, Isohashi F, Yoshioka Y et al (2010) Prognostic factors for survival in patients with recurrent cervical cancer previously treated with radiotherapy. Int J Gynecol Cancer 20:834–840

    Article  PubMed  Google Scholar 

  8. Mabuchi S, Isohashi F, Maruoka S et al (2012) Post-treatment follow-up procedures in cervical cancer patients previously treated with radiotherapy. Arch Gynecol Obstet 286:179–185

    Article  PubMed  Google Scholar 

  9. Fujiwara Y, Yonemori K, Shibata T et al (2015) Japanese universal health care faces a crisis in cancer treatment. Lancet Oncol 16:251–252

    Article  PubMed  Google Scholar 

  10. Mabuchi S, Morishige K, Isohashi F et al (2009) Postoperative concurrent nedaplatin-based chemoradiotherapy improves survival in early-stage cervical cancer patients with adverse risk factors. Gynecol Oncol 115:482–487

    Article  CAS  PubMed  Google Scholar 

  11. Mabuchi S, Isohashi F, Yokoi T et al (2016) A phase II study of postoperative concurrent carboplatin and paclitaxel combined with intensity-modulated pelvic radiotherapy followed by consolidation chemotherapy in surgically treated cervical cancer patients with positive pelvic lymph nodes. Gynecol Oncol 141:240–246

    Article  CAS  PubMed  Google Scholar 

  12. Mabuchi S, Ugaki H, Isohashi F et al (2010) Concurrent weekly nedaplatin, external beam radiotherapy and high-dose-rate brachytherapy in patients with FIGO stage IIIb cervical cancer: a comparison with a cohort treated by radiotherapy alone. Gynecol Obstet Invest 69:224–232

    Article  CAS  PubMed  Google Scholar 

  13. Mabuchi S, Isohashi F, Okazawa M et al (2017) Chemoradiotherapy followed by consolidation chemotherapy involving paclitaxel and carboplatin and in FIGO stage IIIB/IVA cervical cancer patients. J Gynecol Oncol 28(1):e15. https://doi.org/10.3802/jgo.2017.28.e15

    Article  CAS  PubMed  Google Scholar 

  14. Mabuchi S, Takahashi R, Isohashi F et al (2014) Reirradiation using high-dose-rate interstitial brachytherapy for locally recurrent cervical cancer: a single institutional experience. Int J Gynecol Cancer 24:141–148

    Article  PubMed  Google Scholar 

  15. Mabuchi S, Morishige K, Fujita M et al (2009) The activity of carboplatin and paclitaxel for recurrent cervical cancer after definitive radiotherapy. Gynecol Oncol 113:200–204

    Article  CAS  PubMed  Google Scholar 

  16. Mabuchi S, Matsumoto Y, Komura N et al (2017) The efficacy of surgical treatment of recurrent or persistent cervical cancer that develops in a previously irradiated field: a monoinstitutional experience. Int J Clin Oncol 22:927–936

    Article  PubMed  Google Scholar 

  17. Mabuchi S, Kozasa K, Kimura T (2017) Radical hysterectomy after radiotherapy for recurrent or persistent cervical cancer. Int J Gynaecol Obstet 139:185–191

    Article  PubMed  Google Scholar 

  18. Rojas MP, Telaro E, Russo A et al (2005) Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev 1:CD001768. https://doi.org/10.1002/14651858.CD001768.pub2

    Article  Google Scholar 

  19. Jeffery M, Hickey BE, Hider PN (2007) Follow-up strategies for patients treated for non-metastatic colorectal cancer. Cochrane Database Syst Rev 1:CD002200. https://doi.org/10.1002/14651858.CD002200.pub2

    Article  Google Scholar 

  20. Bodurka-Bevers D, Morris M, Eifel PJ et al (2000) Posttherapy surveillance of women with cervical cancer: an outcomes analysis. Gynecol Oncol 78:187–193

    Article  CAS  PubMed  Google Scholar 

  21. Esajas MD, Duk JM, de Bruijn HW et al (2001) Clinical value of routine serum squamous cell carcinoma antigen in follow-up of patients with early-stage cervical cancer. J Clin Oncol 19:3960–3966

    Article  CAS  PubMed  Google Scholar 

  22. Duyn A, Van Eijkeren M, Kenter G et al (2002) Recurrent cervical cancer: detection and prognosis. Acta Obstet Gynecol Scand 81:759–763

    Article  PubMed  Google Scholar 

  23. Lim KC, Howells RE, Evans AS (2004) The role of clinical follow up in early stage cervical cancer in South Wales. BJOG 111:1444–1448

    Article  CAS  PubMed  Google Scholar 

  24. Morice P, Deyrolle C, Rey A et al (2004) Value of routine follow-up procedures for patients with stage I/II cervical cancer treated with combined surgery-radiation therapy. Ann Oncol 15:218–223

    Article  CAS  PubMed  Google Scholar 

  25. Sartori E, Pasinetti B, Carrara L et al (2007) Pattern of failure and value of follow-up procedures in endometrial and cervical cancer patients. Gynecol Oncol 107(1 Suppl 1):S241–247

    Article  CAS  PubMed  Google Scholar 

  26. Zola P, Fuso L, Mazzola S et al (2007) Could follow-up different modalities play a role in asymptomatic cervical cancer relapses diagnosis? An Italian multicenter retrospective analysis. Gynecol Oncol 107(1 Suppl 1):S150–154

    Article  CAS  PubMed  Google Scholar 

  27. Hillesheim I, Limone GA, Klimann L et al (2017) Cervical cancer posttreatment follow-up: critical analysis. Int J Gynecol Cancer 27:1747–1752

    Article  PubMed  Google Scholar 

  28. Utada M, Chernyavskiy P, Lee WJ et al (2019) Increasing risk of uterine cervical cancer among young Japanese women: comparison of incidence trends in Japan, South Korea and Japanese-Americans between 1985 and 2012. Int J Cancer 144:2144–2152

    Article  CAS  PubMed  Google Scholar 

  29. Jeppesen MM, Mogensen O, Hansen DG et al (2017) Detection of recurrence in early stage endometrial cancer—the role of symptoms and routine follow-up. Acta Oncol 56:262–269

    Article  PubMed  Google Scholar 

  30. Forni F, Ferrandina G, Deodato F et al (2007) Squamous cell carcinoma antigen in follow-up of cervical cancer treated with radiotherapy: evaluation of cost-effectiveness. Int J Radiat Oncol Biol Phys 69:1145–1149

    Article  PubMed  Google Scholar 

  31. Chan YM, Ng TY, Ngan HY et al (2002) Monitoring of serum squamous cell carcinoma antigen levels in invasive cervical cancer: is it cost-effective? Gynecol Oncol 84:7–11

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Yuri Matsumoto, Seiji Mabuchi and Fumiaki Isohashi are equally contributed to this study.

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yuri Matsumoto, Seiji Mabuchi, Naoko Komura & Tadashi Kimura

  2. Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Fumiaki Isohashi & Kazuhiko Ogawa

Authors
  1. Yuri Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Seiji Mabuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumiaki Isohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Naoko Komura
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuhiko Ogawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tadashi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seiji Mabuchi.

Ethics declarations

Conflict of interest

The authors declare that no competing financial interests exist.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 17 kb)

Supplementary file2 (DOCX 15 kb)

Supplementary file3 (DOCX 18 kb)

10147_2020_1641_MOESM4_ESM.tif

Supplementary file4 Supplemental Figure 1 Kaplan–Meier estimates of survival (asymptomatic patients vs. symptomatic patients) a overall survival; b post-recurrence survival (TIF 64 kb)

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsumoto, Y., Mabuchi, S., Isohashi, F. et al. Impact of a reduction in follow-up frequency on life expectancy in uterine cervical cancer patients. Int J Clin Oncol 25, 1170–1177 (2020). https://doi.org/10.1007/s10147-020-01641-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10147-020-01641-w

Keywords

Search

Navigation